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A Risk Score to Predict In-Hospital Mortality for Percutaneous Coronary Interventions

https://doi.org/10.1016/j.jacc.2005.09.071Get rights and content

Objectives

Our purpose was to develop a risk score to predict in-hospital mortality for percutaneous coronary intervention (PCI) using a statewide population-based PCI registry.

Background

Risk scores predicting adverse outcomes after PCI have been developed from a single or a small group of hospitals, and their abilities to be generalized to other patient populations might be affected.

Methods

A logistic regression model was developed to predict in-hospital mortality for PCI using data from 46,090 procedures performed in 41 hospitals in the New York State Percutaneous Coronary Intervention Reporting System in 2002. A risk score was derived from this model and was validated using 2003 data from New York.

Results

The risk score included nine significant risk factors (age, gender, hemodynamic state, ejection fraction, pre-procedural myocardial infarction, peripheral arterial disease, congestive heart disease, renal failure, and left main disease) that were consistent with other reports. The point values for risk factors range from 1 to 9, and the total risk score ranges from 0 to 40. The observed and recalibrated predicted risks in 2003 were highly correlated for all PCI patients as well as for those in the higher-risk subgroup who suffered myocardial infarctions within 24 h before the procedure. The total risk score for mortality is strongly associated with complication rates and length of stay in the 2003 PCI data.

Conclusions

The risk score accurately predicted in-hospital death for PCI procedures using future New York data. Its performance in other patient populations needs to be further studied.

Section snippets

Database and study population

The New York State Percutaneous Coronary Intervention Reporting System is a population-based registry that collects detailed information on each patient’s demographic characteristics, pre-procedural risk factors, complications, and discharge status. The risk score system was derived from all 46,090 patients who underwent PCI procedures in 41 hospitals in New York State and were discharged in 2002. It was validated using data from all 50,046 PCI patients who were discharged from New York State

Results

A total of 46,090 PCI procedures were performed in 41 hospitals in New York State in 2002; a total of 321 (0.70%) patients died during their hospital stay. Table 1presents the logistic regression model that was developed to predict in-hospital death using 2002 PCI data. There were nine significant risk factors in the model. Age was represented as a continuous variable, number of years >55; its odds ratio (OR) of 1.07 means that a patient who was over 55 years was 1.07 times likely to die in the

Discussion

In this study, a risk score system for predicting the risk of in-hospital mortality for PCI was developed based on the data of 46,090 procedures performed New York in 2002. The system was then validated using data collected from 50,046 procedures in 2003. This study had the advantage of using the data collected by a well-established population-based registry, the New York State Percutaneous Coronary Intervention Reporting System, whose accuracy of data is maintained by continuous auditing of

Acknowledgments

The authors would like to thank Kenneth Shine, MD, the Chair of New York State’s Cardiac Advisory Committee (CAC), and the remainder of the CAC for their encouragement and support of this study; and Paula Waselauskas, Donna Doran, Kimberly Cozzens, and the 45 participating hospitals for their tireless efforts to ensure the timeliness, completeness, and accuracy of the registry data.

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